12 May 2009

Will child abuse expert doctors be too eager to call something abuse?

Being a child abuse expert is soon to become a medical specialty within pediatrics. It is hard to take a critical view toward this, I'm mean who wouldn't want experts to help us identify such heinous crimes against children?

However, specialization comes with a significant cost, as many generalists in medicine can attest. The adage that is often used is "when you're a hammer, everything looks like a nail." To a cardiologist, everything is a heart problem, and so on. The problem with specialization is that - like anyone - the specialist doctor can become overly invested in their knowledge niche, which is narrow and circumscribed. This can lead to bias, over-simplified conclusions, and missed insights.

My concern is of a slippery-slope nature. How much behavior toward a child will fall under the scrutiny of the child abuse expert? Good old fashioned discipline, such as spanking or washing out the mouth with soap, that many older adults experienced at the hands of their own parents? Forcing a childing to do house chores when they don't want to do? Making a child eat veggies when they refuse? These seem to be a far cry from "abuse" but there is little doubt that our politcolegal culture has also lost common sense in matters of personal responsibility - a disciplining children probably lies at the heart of that.

Here's a recent story about a daycare that was charged with putting hot sauce on tongues and squeezing arms of children that were misbehaving. You can question the style of discpline, certainly, but to call this abuse - as some in the community are - sounds like overreaction (we don't know the whole story). Ideally a child abuse expert could assist in the case with objective appraisal of evidence and clarifying what is and is not abuse. But this could backfire if everything starts to look like a nail.

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